Relation between catastrophizing and depression in chronic pain patients

The relation between catastrophizing, depression, and pain was examined in 125 chronic pain patients. The Coping Strategies Questionnaire (CSQ; Rosenstiel & Keefe, 1983) assessed patients' use of cognitive and behavioral strategies to cope with chronic pain. A significant association between catastrophizing and depression was found. In order to address questions of measurement redundancy, 6 clinical psychologists rated the degree to which items on the CSQ reflected depressive symptomatology. All items contained in the Catastrophizing subscale were rated by all psychologists as being reflective of symptoms of depression and were removed from the CSQ. When this subscale was excluded, none of the remaining CSQ subscales were significantly related to depression. The discussion addresses the interpretive difficulties that arise from hypothesizing mediating relations between variables that are conceptually and operationally confounded.     

The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients

Abstract

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models suggested that depression had a direct influence on the evaluative and affective aspects of pain, but the relationship between depression and sensory pain was mediated by somatic focus. These results provide partial support for Fields' neurobiological model of pain and depression.     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

OBJECTIVE: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. METHOD: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. RESULTS: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. CONCLUSION: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy.     

Information processing in chronic pain disorder: A preliminary analysis

Researchers have alternately suggested selective attention, impaired stimulus filtering, and affective language deficiency models as accounting for multiple somatic complaints in persons with chronic pain disorder. The purpose of the present study was to establish the comparative usefulness of these three models for explaining somatic focus in a chronic pain population. Nine chronic pain patients evidencing high somatic focus (somatizing chronic pain patients), 10 chronic pain patients evidencing low somatic focus (nonsomatizing chronic pain patients), and 10 healthy control subjects were administered a computerized version of the emotional Stroop test as a test of these models. A total of 105 pain-, depression-, and neutral-content words were used as Stroop test stimuli. Stroop test color-naming response latencies were submitted to a two-way Group × Word Type mixed-model ANOVA, with Word Type as the repeated measure. Results reveal that neither the selective attention model nor the affective language deficiency model adequately explain Stroop test performance in somatizing chronic pain patients. Findings provide tentative support for the impaired stimulus filtering model, with somatizing chronic pain patients evidencing similar Stroop test response delays across all words. These results suggest that chronic pain sufferers misinterpret bodily sensations. Findings are discussed in terms of a bilevel approach for treatment of somatizing chronic pain patients that would include assisting the patient in accurate appraisal and interpretation of physical symptoms.     

The response styles theory of depression: A test of specificity and causal mediation

This prospective study tested the diathesis-stress and causal mediation components of the response styles theory of depression. In addition, it examined whether rumination predicts increases in anxious as well as depressive symptoms. At Time 1, 87 college students completed measures of rumination, hopelessness, depressive symptoms, and anxious symptoms. Participants also completed measures of hopelessness, depressive symptoms, and anxious symptoms at three time points later in the semester: immediately after receiving their most difficult midterm exam grade (Time 2), 4–8 hours later (Time 3), and 4 days later (Time 4). Regardless of exam outcome, the tendency to ruminate in response to depressed mood was associated with: (1) increases in anxious symptoms between Time 1 and Time 3; and (2) increases in both anxious and depressive symptoms between Time 1 and Time 4. In addition, the relationship between rumination and increases in both depressive and anxious symptoms was mediated by hopelessness. In other words, individuals with a ruminative response style exhibited increases in both depressive and anxious symptoms because they exhibited increases in hopelessness.     

A general approach to causal mediation analysis

Traditionally in the social sciences, causal mediation analysis has been formulated, understood, and implemented within the framework of linear structural equation models. We argue and demonstrate that this is problematic for 3 reasons: the lack of a general definition of causal mediation effects independent of a particular statistical model, the inability to specify the key identification assumption, and the difficulty of extending the framework to nonlinear models. In this article, we propose an alternative approach that overcomes these limitations. Our approach is general because it offers the definition, identification, estimation, and sensitivity analysis of causal mediation effects without reference to any specific statistical model. Further, our approach explicitly links these 4 elements closely together within a single framework. As a result, the proposed framework can accommodate linear and nonlinear relationships, parametric and nonparametric models, continuous and discrete mediators, and various types of outcome variables. The general definition and identification result also allow us to develop sensitivity analysis in the context of commonly used models, which enables applied researchers to formally assess the robustness of their empirical conclusions to violations of the key assumption. We illustrate our approach by applying it to the Job Search Intervention Study. We also offer easy-to-use software that implements all our proposed methods.     

Caregiver models of self and others, coping, and depression: predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed. and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs.     

Personality,cancer and cardiovascular disease: A causal analysis

This study attempts to investigate the relationship between personality, stress and disease, particularly cancer and cardiovascular disease, both from the correlational and the causal points of view. It is concluded that there is good ecidence linking these diseases with different patterns of personality, and that these links suggest a causal relation. Hypotheses are suggested as to the nature of these causal relations, and it is also suggested that these hypotheses can be used to good advantage in constructing effective methods of behaviour therapy, both prophylactic and curative.     

A causal model for causal priority

Recent attempts to fix the direction of causal priority without reference to the direction of temporal priority have begun with an analysis of the causal relation itself. I offer a method, based on causal modelling theory, designed to determine the direction of causal priority while remaining as agnostic as possible about the nature of the causal relation.     

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.     

The contribution of negative reproductive experiences and chronic medical conditions to depression and pain among Israeli women

This study of 302 Israeli women sought to investigate the associations among stressful reproductive experiences (e.g. fertility problems, abortions, and traumatic births), chronic medical conditions, pain, and depression. The specific aims of the study were to examine (1) the effect of stressful reproductive experiences, chronic medical conditions, and pain on depressive symptoms and (2) the effect of stressful reproductive experiences, chronic medical conditions, and depressive symptoms on pain. Our findings corroborate with previous studies demonstrating that depression and pain are two interrelated, but different phenomena, which have both common and distinct risk factors. The findings are discussed in the light of stress and adaptation theories that point to the long-term effects of stressful life events on emotional and physiological aspects such as depression and pain.     

Age analysis of cognitive-behavioral group therapy for chronic pain outpatients

This study explored the effectiveness, in terms of age of the client, of a 10-week cognitive-behavioral group therapy (stress inoculation training) for chronic pain. A total of 69 outpatients between the ages of 27 and 80 (M = 52.74 years, SD = 14.40) with diverse types of chronic pain were assigned randomly to immediate or wait-list-delayed therapy. Self-report measures of pain, activities, coping, and the use of medications and other physical pain control techniques were obtained at baseline, during therapy, and at 1- and 6-month follow-up. Treatment decreased the degree to which pain interfered with activity, increased ability to cope with pain, and decreased use of some medications and other physical treatments. It had little effect on perceived pain intensity. Gains were maintained through 6-month follow-up. Age was unrelated to outcome. Stress inoculation training appears to be an effective method of ameliorating the interference of chronic pain with the daily activities of life for adults of all ages.     

Reward behavior by male and female leaders: A causal inference analysis

This research investigated causal inferences between leader reward behavior (positive and punitive) and subordinate goal attainment, absenteeism, and work satisfaction over a 3-month period in a merchandise distribution center (n = 252). Four groups were studied: (a) male supervisors-male subordinates, (b) male supervisors-female subordinates, (c) female supervisors-female subordinates, and (d) female supervisors-male subordinates. Using the techniques of tests of mean differences and corrected cross-lag correlations, the results revealed that: (a) No significant differences attributed to sex were found between the four groups with the perceptions of leader reward behavior or subordinate outcome measures, and (b) the causal inference analysis suggested that the relationships between leader reward behavior and subordinate attitudes and behavior were independent of the effects of sex of supervisor or subordinate. Implications for research on sex stereotypes and leadership were discussed.